LD 416
pg. 1
LD 416 Title Page An Act To Amend the Laws Regarding Submission of Health Insurance Claims Page 2 of 2
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LR 1474
Item 1

 
Be it enacted by the People of the State of Maine as follows:

 
Sec. 1. 24-A MRSA §1912, as amended by PL 2003, c. 469, Pt. D, §3
and affected by §9, is further amended to read:

 
§1912. Standardized claim forms

 
All administrators who administer claims and who provide
payment or reimbursement for diagnosis or treatment of a
condition or a complaint by a licensed health care practitioner
must accept the current standardized claim form for professional
services approved by the Federal Government and submitted
electronically. All administrators who administer claims and who
provide payment or reimbursement for diagnosis or treatment of a
condition or a complaint by a licensed hospital must accept the
current standardized claim form for professional or facility
services, as applicable, approved by the Federal Government and
submitted electronically. An administrator may not be required
to accept a claim submitted on a form other than the applicable
form specified in this section and may not be required to accept
a claim that is not submitted electronically, except from a
health care practitioner who is exempt pursuant to Title 24,
section 2985. With the exception of claims for emergency room
services and pathology services, all claims for professional
services must be submitted on the standardized federal form used
by noninstitutional providers and suppliers to bill for Medicare
Part B covered services.

 
Sec. 2. 24-A MRSA §2436, sub-§2-A, as amended by PL 2003, c. 469, Pt.
D, §3 and affected by §9, is further amended to read:

 
2-A. Except as provided in this subsection, for purposes of
this section, an "undisputed claim" means a timely claim for
payment of covered health care expenses under a policy or
certificate providing health care coverage that is submitted to
an insurer within 30 days of the date of service on the insurer's
standard claim form using the most current published procedural
codes with all the required fields completed with correct and
complete information in accordance with the insurer's published
claims filing requirements. After October 16, 2003 and until
October 16, 2005, for a provider with 10 or more full-time-
equivalent employees, an "undisputed claim" means a timely claim
for payment of covered health care expenses under a policy or
certificate providing health care coverage that is submitted to
an insurer, within 30 days of the date of service, in the
insurer's standard electronic data format using the most current
published procedural codes with all the required fields completed
with correct and complete information in accordance with the
insurer's published claims filing requirements. This


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